Indian Man Has a Hysterectomy: What Does That Mean?

The Telegraph reported last week that after a man in India was admitted to a hospital near Bhopal with stomach pain, exploratory surgery on what was thought to be a routine hernia revealed a “complete female reproductive system” in his belly. According to the Telegraph, this included a “female uterus, ovaries, Fallopian tubes, a cervix and underdeveloped vaginal tissue.” The man in question is being identified as “Ryalu” to protect his right to privacy.

Here’s more:

Dr Pramod Kumar Shrivastava, a surgeon at the Chhindwara district hospital said the patient had external male organs, was fit from working in the fields, and lived a normal life.

“Usually the contents of the Hernia Sac are abdomen organs like large intestines and small intestines but when we operated on the patient we were surprised to find female reproductive organs. We have removed the organs through a hysterectomy and repaired the hernia.

“The sac contained quite developed uterus, both the ovaries, Fallopian tubes, cervix and a tissue which is undeveloped but apparently looks like vaginal tissue,” he explained.

The man had not suffered any problems until the stomach pains which led him to hospital. Although he is medically a hermaphrodite, his hormones and sexuality are clearly male, [Dr. Shrivastava] said.

“The external reproductive organs of the patient were masculine and he has no problems whatsoever with his sexuality. He had functional male genitals and there was no formation of breasts in the patient. It’s an embryological accident at the time of embryonic formation,” he said.

I’m mildly pleased by the largely neutral nature of the reporting here by Telegraph New Delhi correspondent Dean Nelson; it’s left to the commenters to make dumbass jokes about the story. But nonetheless, there’s a batch of incomplete information in the story proper.

Some of it is from the imprecise description in phrases like “his hormones and sexuality are clearly male” and “he had functional male genitals.” These two statements mean enormously different things to different people, but they should basically mean the same thing to physicians anywhere in the world. Sadly, these claims don’t answer the important questions, and beyond that there’s two major WTF‘s in the story above.

First, as I mentioned, “Sexuality clearly male” could mean about a zillion things, but I’m going to (perhaps unwisely) assume that Dr. Shrivastava has, in that statement, intended to answer the most specific question, which is about sexual function, which seems to be “male.” But does that mean “He gets a penile erection when aroused,” or “He has fathered children”? The man is said to be the father of two, but the story does not specify whether these are his biological children. Furthermore, even if they are believed to be his biological children, clearly only a DNA test could determine absolutely that they are, which would probably be well outside the appropriateness of any news story about it.

Second, and far more important to any real understanding of Ryalu’s case, only a DNA test could determine whether Ryalu himself has XY chromosomes (typically resulting in what tends to be described as a a male body), XX chromosomes (typically resulting in what tends to be described as a female body), or another configuration entirely. (There’s quite a lot of them, actually, though they’re all rare compared to the big two). I don’t begrudge the Telegraph for not reporting that — there wouldn’t have been time to do it yet even if those tests were ordered. But Ryalu is said to be a hermaphrodite, which is significant by its rarity if what’s meant is that he’s a true hermaphrodite.

It isn’t just that I’m a busybody. Every person with atypical genital configuration provides new information about how genitals develop, therefore providing critical data points for a too-small body of knowledge on intersex conditions, and hopefully increasing the likelihood that other people with similar conditions will receive appropriate care.

A duty to medical science, of course, should absolutely remain secondary to the duty of medical practice, so Ryalu’s right to privacy should be protected. But it’s also important that the Telegraph says what it means, and doesn’t put out misinformation. I get the sense that Dean Nelson has the best of intentions, but the information he’s provided is at best incomplete, and at worst inaccurate. To my mind, every piece of misinformation about these topics, no matter how apparently innocuous, contributes to an environment in which the traits of physical sex are unpredictable and hazardous, and people who do not fit clearly into one of two extraordinarily limited categories are viewed as aberrations.

But not every human fits into one of two categories when it comes to chromosomes, or two categories when it comes to reproductive system development, or physical genital presentation.

Put gender, lifestyle and orientation into the mix, and the misinformation and lack of specificity — like referring to someone as “sexually male” without stating what that means — lets the reader make up their own mind as to what they think that means. But it could mean anything. The assertion that most readers would make, that “everybody knows” what it means to be “male,” is boneheaded in this context — and yet it’s a common assertion. I find it ridiculous when talking about gender roles, but it’s equivalently problematic when talking medically. When talking about a “hermaphrodite,” which the Telegraph claims Ryalu is, “sexuality male” meaning “pops a boner” or “fathers children” — or some other descriptor entirely — is not just important, it’s critical.

The Telegraph’s statement that Ryalu “is medically a hermaphrodite” is treated with a little more casualness than I think it should get. True hermaphrodism is extremely rare. In fetal development, the same tissues develop into either testicles or ovaries, a clitoral head or a penis head, labia or scrotum. However, it’s possible for certain variations upon fertilization to produce a person with both male and female reproductive organs. One of these seems to involve there being a second fertilized ovum with is then absorbed.

Far more common is pseudohermaphrodism, “in which an organism is born with secondary sex characteristics or a phenotype that is different from what would be expected on the basis of the gonadal tissue (ovary or testis).” An example pertinent here would be someone who is born with female internal organs (a uterus, ovaries, fallopian tubes), but whose vagina fused during fetal development. Atypical female hormone development might then result in what would be called a clitoris if the person was labeled female, but is far larger than a typical clitoris might be expected to be. The same tissues that develop into labia also develop into scrotal tissue, so a scrotum could appear to be evident.

A clitoris generally gets erect just like a penis, and a childhood with a body that produces “male” hormones would result in a clitoris/penis that gets quite a bit bigger than most people would generally expect a clitoris to. This person would be chromosomally female, but would have a functional penis (sexually — that is, able to penetrate and feel pleasure) and even a scrotum; however, the scrotum would not have testicles, and the person would not be able to either father a child or carry one.

The condition of pseudohermaphroditism is certainly not common, but it’s far more common than many other human variations. How common any intersex condition is can be a bit hard to sort out. Statistics provided on intersex conditions often wrap man, many different conditions together into one batch — when, in fact, the only thing they have in common is that some part of the person’s physiology, chromosomes or endocrine function does not fit into the tight little categories of “XX chromosomes/body produces female hormones/apparently female body presentation/sexually functional vagina and clitoris/reproductively functional ovaries, fallopian tube, and uterus” or “XY chromosomes/body produces male hormones/apparently male body presentation/sexually functional penis/functional sperm production and delivery.”

Both true hermaphrodism and pseudohermaphrodism are Intersex conditions, and pseudohermaphrodism is far more common than true hermaphrodism (which appears to be exceedingly rare). “Intersex conditions” include a huge number of variations within any one of those areas of development — along with some others, like genital size…which may be completely unrelated to any of the other elements above, but can result in a child born chromosomally and biologically male being “made” female through early surgery, strictly because his penis is “too small!” This is not where the story ends in such cases; see the excellent documentary “XX, XY” for more information.

These kinds of surgeries were all too common in the United States for a very long time. They became less common as advocacy groups like the Intersex Societies of North America and more recently Accord Alliance have sought to increase public awareness of intersex issues.

Now, another note about misinformation…this one regarding, you guessed it, pesticides. Pesticides!? Pesticides.

Read the comments on the Telegraph article, and you get a nice little snapshot of the human race. There are some weirdly unfunny gender-jokes…mostly not all that horribly offensive, possibly because the Telegraph does a decent job of screening them.

But there’s also the speculation that because Ryalu was admitted to a Bhopal hospital, his condition is caused by the December, 1984 Bhopal disaster, in which a Union Carbide pesticide plant released enough poison to expose a total of 558,000+ residents to highly poisonous gas.

The claim made by the commenter is that clearly because Ryalu lived in Bhopal, those freaky chemicals must have done something to him! Freaky chemicals, freaky chemicals, freaky chemicals. Sound familiar? Sure does! I saw it on late-night TV. Beyond the lack of respect shown to medical science and sex/gender by the lack of specificity in articles like this, we also get to see the First World’s love of slapping horror-movie explanations on Third World problems.

So here’s where I get mad.

Anyone speculating that Ryalu’s condition owes anything to the Union Carbide disaster needs to know what the hell they’re talking about, and have data to back it up. They’d better know chemistry and developmental biology, or they’re just a conspiracy nut pulling an idea out of their ass, because that’s the only damn thing Westerners knowabout Bhopal. But Bhopal is a city of nearly 3 million people; more people live there than any U.S. city except New York or Los Angeles. A lot happens there.

There is no direct indication that cases of industrial poisoning with the substances dispersed at Bhopal causing anything like this level of birth variation. “Chemicals” are not some glowy green substance that leaks out of the plant in a sci-fi movie and creates whatever mutations will be advantageous to the development of the narrative. Bhopal does not exist for the amusement of westerners so “freaky hermaphrodites” can salve the neo-colonialist need for an apocalyptic narrative. The apocalypse in 1984 Bhopal was real, and human variation at birth is real. To imply a connection where none exists just because of the attractiveness of a satisfying narrative does a disservice to science, to people with intersex conditions, and to the victims of the Bhopal tragedy.

Westerners interested in what really happened at Bhopal in 1984 can find a number of great books on the tragedy, including Dominique LaPierre’s Five Past Midnight in Bhopal. It was a horrifying tragedy, but the specific human variation in Ryalu’s case has not been credibly described as stemming from such chemicals. And reporting that Ryalu is a “hermaphrodite” without clarification is incomplete information.

Incidentally, the article says Ryalu is being supported by his family, which is nice to hear. It can’t be fun to find out in mid-life that one has some extra organs that need to be removed, so good luck to Ryalu and his family.

Image: Photo by Flickr user O. de Andrade. According to the German caption, this is an aluminum sculpture 11 meters tall by Maine-based American sculptor Jonathan Borofsky.